Focus on Pharmacology: Essentials for Health Professionals, 3e (Moini) Chapter 4 Drug Toxicity and Pharmacogenomics

1) Side effects are generally predictable, and their intensity is:

A) dose dependent

B) based on the patient's age

C) based on preexisting conditions

D) based on gender

Answer: A

Explanation: A) Side effects are generally predictable, and their intensity is dose dependent. They are peripheral or secondary effects caused by drugs and other agents. Some side effects develop soon after drug use begins, whereas others may not appear until a drug has been taken for weeks or months.

2) Programmed cell death that allows cells to self-destruct is called:

A) necrosis

B) ascites

C) toxicosis

D) apoptosis

Answer: D

Explanation: D) Programmed cell death that allows cells to self-destruct is called apoptosis. This process involves the activation of specific proteins. It is helpful when the process kills damaged cells but does not harm surrounding tissue. In cancer cells, apoptosis is often inhibited.

3) Unknown mechanisms of action of an adverse effect of a drug are referred to as:

A) overdose

B) idiosyncratic

C) prophylaxis

D) polymorphism

Answer: B

Explanation: B) Unknown mechanisms of action of an adverse effect of a drug are referred to as idiosyncratic. These responses are unpredictable reactions to a drug, and occur rarely.

4) The FDA requires serious or unexpected events to be reported within how many days?

A) 3

B) 7

C) 15

D) 30

Answer: C

Explanation: C) The FDA requires serious or unexpected events to be reported within 15 days of occurrence. During new drug application studies, all adverse events must be reported, regardless of their severity. Additionally, once the drug reaches the market, adverse events of all types must still be reported.

5) Any components inside the body to which drugs bind are called:

A) drug targets

B) pathogens

C) genomes

D) autosomes

Answer: A

Explanation: A) Any components inside the body to which drugs bind are called drug targets. They are also influenced by genetic variations. Also called biological targets, they are often proteins within the body that may be modified by drugs, altering their activities. In most cases, common drug targets are either proteins or nucleic acids. More than 50% of drug targets are G protein-coupled receptors.

6) The interferon lambda-3 enzyme is encoded by the IFNL3 gene, which is linked to which of the following infections?

A) meningitis

B) hepatitis A

C) hepatitis C

D) pancreatitis

Answer: C

Explanation: C) The interferon lambda-3 enzyme is encoded by the INFL3 gene, which is linked to hepatitis C infection. In patients with the favorable genotype, these enzymes have resulted in about double the success rate in curing the condition with proper treatment. This involves pegylated interferon with ribavirin, with our without a protease inhibitor.

7) Which of the following is NOT a sign or symptom of anaphylactic shock?

A) paralysis of the diaphragm

B) hypertension

C) urticaria

D) swelling of the oropharynx

Answer: B

Explanation: B) Hypertension is not a sign or symptom of anaphylactic shock, but hypotension is, along with urticaria, paralysis of the diaphragm, and swelling of the oropharynx. The end result may be cardiac collapse. Anaphylactic shock is a true medical emergency, occurring so swiftly and severely that controlled clinical studies of treatment have never been possible.

8) Which of the following drugs are most commonly linked to physical dependence?

A) immunosuppressants

B) antibiotics

C) antihistamines

D) narcotics

Answer: D

Explanation: D) Narcotics are most commonly linked to physical dependence. Narcotics include prescribed opioids as well as illegal drugs such as heroin. Many other drugs produce physical dependence, including amphetamines, barbiturates, and ethanol. Some drugs cause specific type of physical dependence even though their effects are outside of the CNS.

9) The generic name of "Lipitor" is:

A) niacin

B) atorvastatin

C) valproic acid

D) rifampin

Answer: B

Explanation: B) The generic name of Lipitor is atorvastatin. It is an example of a "statin", used to lower lipid levels. Other examples of statins and lipid-lowering drugs include fenofibrate, fluvastatin, gemfibrozil, lovastatin, niacin, pravastatin, and simvastatin.

10) Anaphylaxis is an example of type ________ allergic drug reactions.

A) I

B) II

C) III

D) IV

Answer: A

Explanation: A) Anaphylaxis is an example of type I allergic drug reactions. It is also referred to as "immediate hypersensitivity". Examples of drugs or classes of drugs linked to anaphylaxis include penicillins, streptomycin, local anesthetics, neuromuscular-blocking drugs, and radiologic contrast media.

11) Type II allergic drug reactions are described as:

A) immediate hypersensitivity

B) immune complex-mediated hypersensitivity

C) antibody-dependent cytotoxic hypersensitivity

D) delayed-type hypersensitivity

Answer: C

Explanation: C) Type II allergic drug reactions are described as antibody-dependent, cytotoxic hypersensitivity. Examples of drugs or classes of drugs linked to these reactions include quinine, quinidine, rifampicin, and metronidazole. When such a reaction occurs, the drug binds to (usually) red blood cells, and is recognized by the antibody (primarily, IgG).

12) Epinephrine is frequently injected to combat anaphylactic shock, but must be administered:

A) after 8 hours

B) after 24 hours

C) within the intensive care unit only

D) soon after shock begins

Answer: D

Explanation: D) Epinephrine is frequently injected to combat anaphylactic shock, but must be administered soon after shock begins. Epinephrine is also known as adrenaline. Patients who are predisposed to allergic reactions should wear an alerting bracelet or necklace such as Medic Alert®.

13) Before administering a drug, knowledge of a patient's ________ is essential.

A) allergies

B) Rh factor

C) blood type

D) family history

Answer: A

Explanation: A) Before administering a drug, knowledge of a patient's allergies is essential. Ask all patients if they have a history of allergies, such as hay fever, rashes, or asthma; or have had unusual reactions to any drugs taken orally or by injection in the past.

14) When a drug to which a person has become physically dependent is discontinued, what will occur?

A) anaphylactic shock

B) toxicity

C) tolerance

D) abstinence syndrome

Answer: D

Explanation: D) Abstinence syndrome will occur when a drug is discontinued to which the user has become physically dependent. Each drug's abstinence syndrome is unique.

15) How many adverse drug events occur annually in hospitals?

A) more than 770,000

B) more than 320,000

C) less than 120,000

D) less than 25,000

Answer: A

Explanation: A) More than 770,000 adverse drug events occur annually in hospitals. This is often because of unclear or missing drug information.

16) An interaction between two drugs that causes an effect greater than that which would have been expected from the additive properties of the drugs involved is called:

A) physical dependence

B) polymorphism

C) potentiation

D) overdose

Answer: C

Explanation: C) Potentiation is the term that describes an interaction between two drugs causing an effect greater than that which would have been expected from the additive properties of the drugs involved. For example, alcohol potentiates the sedating effects of the tranquilizer diazepam (Valium®) when the two drugs are ingested at the same time.

17) A drug reaction that is noxious, unintended, and occurs at doses normally used in humans for the prophylaxis, diagnosis, or treatment of disease is known as:

A) an idiosyncratic drug reaction

B) an adverse drug reaction

C) a toxicity reaction

D) a hepatotoxic effect

Answer: B

Explanation: B) An adverse drug reaction is one that is noxious, unintended, and occurs at doses normally used in humans for the prophylaxis, diagnosis, or treatment (therapy) of disease. Examples include severe nausea, vomiting, and diarrhea. Adverse drug reactions may range in intensity from mildly annoying to life-threatening.

18) A drug's adverse effects are based on its:

A) margin of safety

B) manufacturing process

C) date of expiration

D) frequency of use

Answer: A

Explanation: A) A drug's adverse effects are based on its margin of safety, between the effective dose and the toxic dose. An overdose is usually linked to a drug with a large margin of safety, whereas adverse effects can occur from therapeutic doses when the margin of safety is small or nonexistent. Margin of safety applies to all drugs prescription or nonprescription.

19) Pharmacogenomics is focused on genes encoding metabolic enzymes that alter ________.

A) drug distribution

B) drug solubility

C) drug activity

D) adverse effects

Answer: C

Explanation: C) Pharmacogenomics is focused on genes encoding metabolic enzymes that alter drug activity. It was formerly known as pharmacogenetics. It is the study of genetic factors that influence variations in drug responses. More than one genetic variant may play a part in varied drug responses.

20) Which of the following is the fourth major drug-related cause of death, especially among elderly patients in the USA?

A) polymorphism

B) hypersensitivity

C) autoimmunity

D) adverse drug reaction

Answer: D

Explanation: D) Adverse drug reaction(s) are the fourth major drug-related cause of death, especially among elderly patients in the USA. They do occur in patients of all ages, however. More than 770,000 adverse drug events occur annually in hospitals, often because of unclear or missing drug information.

21) Stevens-Johnson syndrome may cause severe damage of which organ?

A) liver

B) pancreas

C) brain

D) heart

Answer: A

Explanation: A) Stevens-Johnson syndrome may cause severe damage of the liver. It is a severe hypersensitivity reaction that can also cause toxic epidermal necrosis. This syndrome is a lifethreatening skin condition, in which cell death causes separation of the epidermis from the dermis.

22) Any drug that causes harm to an embryo is called a(n):

A) carcinogen

B) interferon

C) teratogen

D) allergen

Answer: C

Explanation: C) Any drug that causes harm to an embryo is called a teratogen. Teratogens can also be illnesses that harm embryos. Examples of teratogens include alcohol, cigarette smoke, medications, illegal drugs, some vaccines, certain viral infections, radiation, some occupational chemicals, and maternal autoimmune disorders.

23) Serum sickness is an example of which type of hypersensitivity?

A) I

B) II

C) III

D) IV

Answer: C

Explanation: C) Serum sickness is an example of type III hypersensitivity. This type requires formation of antibodies, usually IgG or IgM, against soluble antigens. Complexes of antigens and antibodies are then deposited in tissues, primarily the joints, kidneys, and lung vascular endothelium. Serum sickness involves inflammation due to activation of complement and leukocytes inside the tissues.

24) Which of the following drugs may cause "Red man syndrome"?

A) penicillin

B) vancomycin

C) bupropion

D) cefaclor

Answer: B

Explanation: B) Vancomycin may cause Red man syndrome, which is a rare condition involving degranulation of the mast cells that is independent of preformed complement or IgE. Other drugs that cause Red man syndrome include amphotericin B, ciprofloxacin, rifampicin, and teicoplanin. Usually, wheals and urticaria of the skin develop on the neck, arms, and upper trunk.

25) Which of the following is most often linked to cumulative toxicity?

A) ethyl alcohol

B) methyldopa

C) aspirin

D) caffeine

Answer: A

Explanation: A) Ethyl alcohol is most often linked to cumulative toxicity, out of the answer choices. This may occur rapidly. A cumulative effect occurs when the body is not able to metabolize and excrete one dose of a drug completely before the next dose is given. With repeated doses, the drug starts to collect in the blood and body tissues.

26) The combined action of two drugs that produce an effect greater than each of their unique effects is called:

A) cumulative

B) tolerance

C) polypharmacy

D) synergism

Answer: D

Explanation: D) The combined action of two drugs that produce an effect greater than each of their unique effects is called synergism. Some drug interactions exhibit synergism, which, depending on the circumstances, may be beneficial or harmful. An example of harmful synergism is the combination of aspirin with the anticoagulant warfarin (Coumadin®), which can reduce blood clotting to the extent of spontaneous hemorrhage if doses are not carefully monitored.

27) An example of an herbal supplement that interacts with NSAIDs is:

A) cranberry

B) ginkgo biloba

C) chondroitin

D) saw palmetto

Answer: B

Explanation: B) Ginkgo biloba is an example of an herbal supplement that interacts with NSAIDs. Since both agents inhibit platelet aggregation, concurrent use may increase risk of bleeding.

28) The bacterial peptidoglycan cell wall is a drug target for certain ________ drugs.

A) antifungal

B) antiviral

C) antibacterial

D) antiprotozoal

Answer: C

Explanation: C) The bacterial peptidoglycan cell wall is a drug target for certain antibacterial drugs. These drugs interrupt peptidoglycan synthesis. Cell lysis results from abnormal cell wall synthesis. Penicillins can harm these drug targets while causing little toxicity to normal cells.

29) A chemical inside an organism that is NOT normally produced or even expected to be present is called:

A) xenobiotic

B) a peptidoglycan

C) aspartate aminotransferase

D) alanine aminotransferase

Answer: A

Explanation: A) A chemical inside an organism that is not normally produced or even expected to be present is called xenobiotic. Many drug products are xenobiotics. Plasma membrane transporters mediate selective uptake as well as removal of endogenous compounds and xenobiotics. Transporters work with drug-metabolizing enzymes to a great degree.

30) Which of the following is NOT an example of an antifungal?

A) itraconazole

B) ketoconazole

C) terbinafine

D) simvastatin

Answer: D

Explanation: D) Simvastatin is not an example of an antifungal. It is a statin, which helps to lower lipid levels in the body. Examples of antifungals include: itraconazole, ketoconazole, and terbinafine.